COVID-19: dental trainees and redeployment

redeploymentCourtney Orloff, Priya Patel and Sancia Fernando share their experiences of redeployment and helping the NHS in the fight against COVID-19.

The coronavirus pandemic has impacted all aspects of society – dentistry included. Given the aerosol-generating nature of many procedures, the close proximity between patients and members of the dental team, and the number of patients we see every day, routine dentistry has been brought to a halt.

During lockdown, many dentists were left out of work and facing financial challenges. However, there were a number of redeployment opportunities to help the NHS and wider community.

Stepping up

Redeployment options have pushed us to work far beyond our comfort zones. Volunteers were requested and those that volunteered had a variety of different options. These included both patient facing as well as non-patient facing roles. Such as 111 call handling, clinical support within intensive care units in both the London Nightingale Hospital and Northwick Park Hospital, and roles within local pharmacies.

Like so many other healthcare professions, dentists have truly stood up to help.

Northwick Park Hospital was one of the first hospitals to be severely impacted by coronavirus. By mid-March, the demand on ICU had reached unprecedented levels and Northwick Park had quadrupled the number of intensive care beds available in response; it also made a call for volunteers from all departments across the trust to help already strained resources.

It was at this point that foundation dentist volunteers were recruited from across the London and KSS schemes. Luckily (and unsurprisingly), an impressive number stepped forwards to help on the front line.

Proning patients

As foundation dentists and a dental core trainee, our role involved ‘proning’. Proning has been utilised as a successful adjuvant therapy for suitable patients who have gone on to develop severe acute respiratory distress syndrome (ARDS) with worsening hypoxaemia. These complications can occur as COVID-19 progresses to COVID-19 pneumonitis, which can be life-threatening.

The procedure was previously adopted by health professionals in China and Italy with favourable results. There is evidence that moving the patient from a supine position to a prone position, while being ventilated, improves oxygenation and, therefore, causes a decrease in mortality (Mora-Arteaga, Bernal-Ramírez and Rodríguez, 2015).

The procedure does not come without risks. These include endotracheal tube displacement, loss of venous access, and pulling of catheters and chest drains. The procedure requires a minimum of five people and communication is key.

Teams are typically made up of professionals from a range of specialities. Masks and visors make speaking and hearing difficult.

In line with NHS guidance, we have also carried out other roles in the intensive care unit. Principally this has involved supporting the nurses – we help with turning and hygiene – which, of course, includes oral hygiene too.

Challenges and opportunities

The future of dentistry is uncertain. Our proximity to patients’ mouths, the aerosol-generating procedures we use, and the sheer number of patients that we see throughout the day all means that practising dentistry ‘normally’ is impractical and unsafe (for both patients and dentists).

As new entrants to our profession, we are faced with significant uncertainty. Given the current climate, it is unclear when dental practices will fully return to normal. And if there will be associate positions available for us to transition into.

While redeployment has undoubtedly been challenging for us all, it has also brought unique opportunities. Such as learning to work with other healthcare professionals in a stressful environment, developing our communication skills as we lose access to non-verbal cues hidden behind layers of PPE and, most importantly, allowing us to play our role in the NHS fight against COVID-19.

In foundation dentists Courtney and Priya’s words…

Prior to our redeployment, we were both working in dental practices situated in west London. Working on an intensive care unit has been a steep learning curve.

Our days usually consist of a nine to five job, where we are sat down and interacting with our patients. Intensive care has been quite the opposite! The change in role has created both physical and mental challenges. We were not prepared for how physically exhausting we would find being on our feet for 12-hour night and day shifts. You can walk many miles per shift and proning patients can be heavy work (obesity is recognised as a comorbidity – worsening the COVID-19 prognosis).

Another hurdle has been the mental challenges of intensive care; as a dentist you do not anticipate seeing patients convulse in unconscious states, let alone dying in front of you.

While this experience has been difficult, it has also provided us with an opportunity to grow and nurture skills that will benefit us in the future, most importantly communicating and working together with other healthcare professionals. Physiotherapists, occupational therapists, nurses, junior doctors, registrars and consultants from all specialities including anaesthetics and surgery are just a few of the other healthcare professionals we have had the pleasure of interacting with and learning from during our redeployment. Everyone has been keen to share their knowledge. Although our training has been interrupted, we are gaining skills and experience in other ways!

In dental core trainee Sancia’s words…

Prior to redeployment into intensive care, I was working as an oral and maxillofacial (OMFS) DCT1 at Northwick Park Hospital.

As we saw the crisis evolving, there were drastic changes to the way the hospital ran. Within our department we transitioned to telephone clinics and modified the way we managed our A&E OMFS referrals, in line with BAOMS guidance.

By volunteering to help assist the COVID-19 workforce we had the opportunity to work with other redeployed colleagues from a variety of specialties.

As OMFS surgical cases branch from major oncology to managing rapidly spreading cervico-facial infections many of our patients require intensive care admission for post-surgical care. Redeployment has enabled DCTs to develop an understanding of the way intensive care is run. We will take this knowledge back with us when training resumes.

For references, email [email protected].

First published in Dentistry magazine. For more articles like this read Dentistry magazine here.

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